Lear Von Koch, M.D., operated a couple of years ago on a man who weighed 485 pounds.

It was an operation that posed challenges for the chief of cardiothoracic surgery at Regional Hospital of Scranton, and one of which his counterparts from the 1960s and '70s likely never dreamed.

For them, patients consisted mainly of middle-aged men needing a bypass or two. The patient net has widened since then as medicine and skills have improved, however, making it possible for surgeons like Dr. Koch to operate on not only people from both genders but also those with larger bodies.

And with obesity rates on the rise, people are developing medical issues that require the skills of surgeons like Dr. Koch. The incidence of obesity and congestive heart failure have been on a linear rise since the 1980s, he said, the same time he noticed more obese people coming for surgery and the popularity of fast food skyrocketing.

"We've become a nation of fast-food eaters who are more and more sedentary," Dr. Koch said.

More obese patients

Dr. Koch pointed out how a 2006 study determined obesity to be an "independent risk factor" for developing cardiovascular problems and atherosclerosis. Obesity also can lead to the "metabolic syndrome," he said, a combination of being overweight or obese, diabetes, hypertension and hormonal problems. Obese people also have physically larger hearts that cannot fill with blood as easily as average hearts.

"As a person becomes more and more obese and the heart becomes bigger and thicker, eventually the heart is not as compliant," Dr. Koch said.

Obesity, age, genetics, smoking and hypertension account for practically all of the problems Dr. Koch sees, which most often are coronary artery disease, aortic valvular stenosis and mitral valve insufficiency.

"We do see more and more obese people," Dr. Koch said. "Those of us who are doing a lot of this (surgery), who are good at doing a lot of this, we're getting referred more and more high-risk patients, including the very obese."

Operating on obese and overweight people comes with risks for the patients and challenges for the surgeons. Patients with weight problems face the possibility of developing respiratory and other infections and blood clots. Doctors have to figure out how to access the heart and other vital organs during surgery and deal with patients who also have other problems, like diabetes or kidney dysfunction.

"The risks are less when patients are in the right (weight) range," Dr. Koch said. "The highest-risk patients are people who are obese or cachectic, at the other end of the scale. And the long-term prognosis is best in people who are more toward the normal range, who don't smoke, whose blood pressure is normal. ... All of those things get better if an overweight person loses weight."

Dr. Koch is blunt with his patients, but with a smile. Still, he's been known to tell patients when they are TDF - "too damn fat."

"I don't like this business of hiding information from people," Dr. Koch said. "I want people to know what I know so that they'll be well-informed."

Dr. Koch recommends obese people go on a "saucer" diet, in which they ditch their typical 12- or 14-inch plates for a saucer to reduce their food portions.

"You have to eat properly and eat less, that's No. 1," Dr. Koch said. "No. 2, you need to be physically more active. Now, that doesn't mean at age 70 you should go out and try to run a marathon. It just means you need to use your body and your skeleton and your muscles to be as physically active as you can be, even if it's just brisk walking."

Gaining weight often is easy for people, Dr. Koch said, while taking off the pounds can be more difficult because abdominal fat can cause metabolic syndrome. That, in turn, affects blood pressure, the pancreas, insulin sensitivity and hormones and makes losing weight tough.

"And losing weight just for its own sake is probably not good enough," Dr. Koch added. "People need to be physically more active, too."

Focus on children

People need to recognize the obesity problem exists, he said, and, in addition to eating healthier, they can combat the epidemic by turning their attention to the next generation.

"We need to focus more and more on children so, as children grow up, they know that they're going to have to eat less than they see others eating, that they need to be physically active," Dr. Koch said. "If you're going to sit in front of a computer for a couple of hours, then you better get up an do something physical for a couple of hours."

Obesity has become a nationwide problem, and Northeast Pennsylvania is no exception.

"When I go to meetings with my colleagues, we all have the same problem," Dr. Koch said. "We all have people who smoke too much. We all have people who are hypertensive. We all have people who are morbidly obese. We all have people who are older with many, many risks factors. It's the way it is anymore."

Contact the writer: cheaney@timesshamrock.com, @FeaturesTT on Twitter

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